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Bringing Dermatology to the Underserved in Uganda

October 22nd, 2018 / by Nora Daly

When Dr. Leo Odongo moved from Mbarara, Uganda, to the smaller city of Kabale in September 2016, he noticed a concerning trend. Patients in Kabale and the surrounding rural areas did not have access to dermatology services. Even more concerning, few in the community were aware that such services existed.

Though Dr. Odongo relocated to Kabale to start a second residency in obstetrics and gynecology, his previous training as a dermatologist enabled him to recognize the burden of skin conditions and infections within the local community. With no practicing dermatologists in the region, proper treatment was not available.

“I noticed the need for dermatology in this region,” he recalls, “I saw dermatology patients who were attended to by unqualified health workers . . . Since they were not qualified at all there were a number of wrong treatments . . . Also, many patients were not [aware] that dermatology existed.”

Dr. Odongo estimates that there are about 20 dermatologists serving Uganda’s entire population of roughly 44 million. Most of those 20 dermatologists are concentrated in large towns and major cities, including Mbarara, where the country’s only dermatology training center is located.

Prior to Dr. Odongo’s arrival, there were no trained dermatologists in Kabale, and few patients had the resources to travel outside of Kabale for treatment. Recognizing the profound need for his services, Dr. Odongo requested permission to begin offering a free dermatology clinic on Thursdays at Kabale Regional Referral Hospital.

“I talked to the [hospital] administrators . . . They said, ‘Yeah, this is fine, but we don’t have money to pay you.’”

Undeterred, Dr. Odongo volunteered to run the clinic for free while still working toward the completion of his OB/GYN residency. His interactions with patients during the clinic fueled his desire to do more.

“I realized that there were actually many, many people who had skin problems and they didn’t know what to do. And so I imagined it was worse for the people who could not make it to Kabale Regional Referral Hospital.” This included individuals in prisons and orphanages outside of the city.

Dr. Odongo shared his concerns about the patients who were unable to access his clinic with his friend and mentor, Dr. Alexia Knapp. The two met in the Department of Dermatology at Mbarara University of Science and Technology when Dr. Odongo was working there as a dermatologist and Dr. Knapp was volunteering through HVO. When Dr. Knapp returned to the US, she and Dr. Odongo remained in touch. He would consult with her on interesting and challenging cases, particularly after he moved to Kabale and began seeing patients in the clinic.

“[Dr. Knapp] introduced me to . . . a program from the American Academy of Dermatology for skin care in developing countries,” he remembers, “This is how I began to develop the idea for the outreaches.”

Dr. Knapp suggested that Dr. Odongo could apply to AAD for funding to offset the cost of conducting outreach clinics in prisons, orphanages, and other remote areas. Dr. Odongo applied for and was awarded a grant. To date, he has conducted eight outreach clinics including visiting prisons, orphanages, a school for the blind, a refugee camp, and the home of one rural patient.

In a recent report, Dr. Odongo indicated that, through his outreach clinics, he has served at least 253 patients with skin conditions who otherwise would have gone untreated. He has also provided basic training to staff at each clinic location on how to prevent and recognize skin infections.

“I have one general goal,” he says. That is to serve as an ambassador for the profession of dermatology in the Southwestern region of Uganda. So far, he feels he has been successful in this goal. In addition to reaching 253 patients through his outreach clinics, he has treated over 1,500 patients through his Thursday clinic at Kabale Regional Referral Hospital. These efforts have increased awareness of dermatology as a specialty, leading to an increase in demand for dermatologic services and increased respect for the importance of dermatologic care.

“My next goal would be . . . to make sure more skin clinic outreaches are carried out, not only in Southwestern Uganda, but also in other dermatologically underserved regions of the country.”

In addition to carrying out more in-person outreach clinics, Dr. Odongo hopes to establish the practice of teledermatology in Uganda, so health workers and patients in underserved regions can connect virtually with trained dermatologists in Mbarara and other cities. He also hopes to start a Department of Dermatology at Kabale University.

“They have started training medical students [at Kabale University]. They are in their second year of study, so if I succeed in introducing a Department [of Dermatology] this can form another center for training for dermatology in the future.”

Dr. Odongo already knows one medical student at Kabale University who may be interested in specializing in dermatology. The student had the skin condition pyoderma gangraenosum, which can lead to the formation of chronic wounds. Prior to Dr. Odongo’s arrival, this condition was being treated surgically by providers at Kabale Regional Referral Hospital.

“The surgeon had no training in dermatology, so they were cutting out fragments of the wound, so the wound was worsening every now and then.”

When Dr. Odongo arrived he was able to diagnose the condition, stop the debridement of the wound, and deliver appropriate treatment. As a result, the student’s condition improved. Now, when it comes time to choose a specialty, Dr. Odongo hopes this student will remember the positive impact dermatologic care had on his quality of life.

Over time, Dr. Odongo hopes the impact of his outreach clinics will reverberate throughout Uganda. For now, he is content to know he has made a tremendous impact within Kabale.

“Now [patients] know many diseases of the skin can actually be treated, so now they are coming to the hospital . . . so I know this has had a very positive impact,” notes Dr. Odongo.

In addition to the positive feedback he receives from the local community, Dr. Odongo is motivated to continue his volunteer work because of the support he receives from colleagues like Dr. Knapp, and organizations including HVO and AAD.

He acknowledges how challenging it can be to persevere with limited resources and without any compensation for his work, but he adds, “If there are people who are thousands of kilometers away from me who are concerned about the skin health of my people, then I am also encouraged to move on and do something. So, for this I am very grateful.”

Want to show your support for providers like Dr. Odongo? HVO has short-term volunteer opportunities for dermatologists in Cambodia, Costa Rica, Nepal, Uganda and Vietnam. Apply to volunteer today!